外籍看護與家庭照顧者對接受居家照顧老人住院與死亡風險之差異

Differences between foreign care workers and family caregivers in risk of hospitalization and mortality among home care elders in Taiwan

目標：為解決老人照顧人力之需求，我國從1992年開始引進外籍看護，目前已經成為長期照顧人力的主要來源。有鑑於我國開放引進外籍看護二十多年，對於其照顧品質的相關研究仍然相當缺少。因此本研究希望探討由外籍看護照顧，相較於家庭照顧者，對於居家照顧老人預後風險之影響，並分析造成老人預後差異可能的因素。方法：研究資料取自273位新北市某區域醫院附設居家護理所之居家老人護理紀錄，所涵蓋之資料日期從2003年7月至2015年5月。以收案期間死亡與住院事件進行存活分析，比較外籍看護與不同性別、不同親屬關係之家庭照顧者照顧，對居家老人死亡與住院風險之影響。結果：由女性（HR= 0.715）、女兒或媳婦（HR= 0.653）所照顧之老人，其住院風險明顯低於由外籍看護照顧。短期由子女照顧住院風險同樣低於於外籍看護（HR= 0.552），但子女照顧時間超過1.1年之後兩者則無顯著差異。結論：本研究顯示家庭照顧者照顧之老人預後優於外籍看護照顧。政府應重新考量目前外籍看護的開放政策，並對於願意投入照顧工作的家庭照顧者提供更多的長照資源與協助。

Objectives: The purpose of this study was to evaluate the quality of home care provided to older adults in Taiwan whose caregivers were either family members or foreign care workers. Methods: Data from July 2003 to May 2015 was retrieved from the records of a home care agency in new Taipei city. A total of 273 older adults were included for analysis. Cox proportional hazards and recurrent event models were applied to compare the risk of mortality and hospitalization for disabled older adults with caregivers who were foreign workers or family members; in addition, the effects of gender and family roles were determined. Results: Older adults who were taken care of by female family members (HR = 0.715), such as a daughter or daughter-in-law (HR = 0.653), had a significantly lower risk of hospitalization than older adults who were taken care of by foreign care workers. Older adults who were taken care of by their children during early episodes of disability also had lower rates of hospitalization compared to older adults who were taken care of by foreign care workers (HR = 0.552). The differences between these two caregiver roles (children vs. foreign care workers) were not significant when the duration of care lasted ＞ 1.1 years. Conclusions: The study findings showed that family caregivers provided better care to older adults than foreign care workers. The government should re-evaluate the open-door policy for foreign care workers and provide more long-term care resources and support for family caregivers who are willing to take care of disabled older relatives.